Surgical options for advanced renal cell carcinoma

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Advanced renal cell carcinoma (RCC) detection is common, with stage migration due to increased abdominal imaging.
• Minimally invasive surgical techniques (laparoscopic, hand-assisted, robotic) have been developed since open inferior vena cava (IVC) thrombectomy in 1972.
• Open surgery remains the standard of care at academic centers, despite robotic surgery's potential benefits.

Purpose of the Study:

• To review the current surgical management of advanced renal cell carcinoma (RCC).
• To discuss the evolving role of cytoreductive nephrectomy and systemic therapies in advanced RCC.
• To highlight the feasibility and effectiveness of complex surgical undertakings in advanced RCC.

Main Methods:

• Review of surgical approaches for advanced renal cell carcinoma (RCC), including open, laparoscopic, hand-assisted, and robotic techniques.
• Discussion of indications for cytoreductive nephrectomy in metastatic RCC.
• Analysis of the impact of systemic therapy advancements on neoadjuvant and adjuvant treatment strategies.

Main Results:

• Open surgery is the established standard for advanced renal cell carcinoma (RCC) at academic centers.
• Cytoreductive nephrectomy indications are not clearly defined but may be considered for specific patient groups.
• Systemic therapies are advancing, paving the way for neoadjuvant and adjuvant treatments in advanced RCC.

Conclusions:

• Surgical management of advanced renal cell carcinoma (RCC) is complex but feasible and effective.
• The integration of evolving systemic therapies will likely shape future treatment paradigms for advanced RCC.
• Continued research and comparative studies are needed to optimize surgical and systemic treatment strategies for advanced RCC.